Cardio Case Room

Cardiology clinical reasoning cases.
Five a week. By a senior cardiologist (MD, PhD).
Fictional cases only. Not medical advice.

[Cardio Case Room @CardioCaseRoom]

This account posts cardiology clinical reasoning cases.

Five a week. Question in the evening, answer the next morning.

Every case is fictional. No real patient data, ever.
No consultations, no personal advice — please see your own doctor.

[Cardio Case Room @CardioCaseRoom]

@franciscojlk For oral maintenance in pregnancy, I'd use labetalol or extended-release nifedipine. ACE inhibitors, ARBs and direct renin inhibitors are the ones I'd avoid because fetal kidney injury can cause oligohydramnios.

[Cardio Case Room @CardioCaseRoom]

Why not the others:

B — Fetotoxic in the second half of pregnancy.
C — Same problem as the ACE inhibitors.
D — Renin inhibitors are fetotoxic too.
E — Not recommended in pregnancy.

[Cardio Case Room @CardioCaseRoom]

Case 029 — Answer: A. Labetalol or nifedipine

#Cardiology #ClinicalReasoning

[Cardio Case Room @CardioCaseRoom]

Case 029 — Twenty-eight weeks in, her pressure is too high to just watch.

Which treatment would you start first? Why?

#Cardiology #ClinicalReasoning

[Cardio Case Room @CardioCaseRoom]

Why not the others:

A — The lows still happen; only the signal went.
B — The timing points straight at the new drug.
D — They do not lower glucose; they can worsen insulin lows.
E — Insulin is not the problem here.

[Cardio Case Room @CardioCaseRoom]

Case 028 — Answer: C. The drug hid her warning signs

#Cardiology #ClinicalReasoning

[Cardio Case Room @CardioCaseRoom]

Case 028 — Her low sugars used to announce themselves. Now they arrive without warning.

Which one did you pick? Case 028

#Cardiology #ClinicalReasoning

[Cardio Case Room @CardioCaseRoom]

@ManualOMedicine Light–near dissociation. That points to the dorsal midbrain: the pretectal light-reflex pathway is interrupted, while the near response still reaches the Edinger–Westphal nucleus through a separate cortical route.

[Cardio Case Room @CardioCaseRoom]

Why not the others:

B — ACE inhibitors raise potassium, not lower it.
C — Ankle swelling is a calcium
channel blocker problem.
D — They lower pressure; that is the point of them.
E — Cough is real, but it is not why this is unsafe.

[Cardio Case Room @CardioCaseRoom]

Case 027 — Answer: A. Acute renal failure can result

#Cardiology #ClinicalReasoning

[Cardio Case Room @CardioCaseRoom]

@HiraaliCardio Inspiration is the clue: it tests ventricular interdependence. In constriction, the fixed pericardium makes right-heart filling rise at the expense of left-heart filling; restrictive cardiomyopathy lacks that exaggerated coupling.

[Cardio Case Room @CardioCaseRoom]

Case 027 — One imaging finding turns a standard drug into a dangerous one.

Which one did you pick? Case 027

#Cardiology #ClinicalReasoning

[Cardio Case Room @CardioCaseRoom]

Why not the others:

A — Backing off is the instinct the guideline rejects.
B — 138/76 is still above goal; stopping gives up real benefit.
C — Fluids and pressors are for symptomatic drops.
E — Seated-only readings hide the whole problem.

[Cardio Case Room @CardioCaseRoom]

Case 026 — Answer: D. Keep her BP well controlled

#Cardiology #ClinicalReasoning

[Cardio Case Room @CardioCaseRoom]

@EcgOxford @akneton @yolyabreuh @DidlakeDW @ecgrhythms @IhabFathiSulima @DrPharmDMDTh @Vadeboncoeur_Al @smithECGBlog @EM_RESUS @estudiomedicina @OrlandoRPN @fxgodzeuss @ResusMed @TrRja @NaokiThukishima @ecgandrhythmRoe Pseudo-infarct until the old ECG and echo settle it: fixed anterior Q waves with persistent ST elevation and akinesis favor aneurysm; dynamic ST-T change or regional edema favors active myopericarditis.

[Cardio Case Room @CardioCaseRoom]

@heartsECGcourse Treat this as VT first—negative precordial concordance and extreme axis make SVT with aberrancy the exception, not the default.

[Cardio Case Room @CardioCaseRoom]

Case 026 — Her pressure falls 34 points on standing, and the reflex is to back off.

Which one did you pick? Case 026

#Cardiology #ClinicalReasoning

[Cardio Case Room @CardioCaseRoom]

Why not the others:
A — 150 was the old threshold for older adults.
C — No guideline sets a goal of 160.
D — Age alone is not a reason to skip treatment.
E — The diastolic goal is below 80, not 70.

[Cardio Case Room @CardioCaseRoom]

Case 025 — Answer: B. Systolic goal of under 130; lower if tolerated

#Cardiology #ClinicalReasoning

[Cardio Case Room @CardioCaseRoom]

@ManualOMedicine Cardiogenic pulmonary edema. Smooth septal thickening favors hydrostatic edema; nodular or ground-glass opacities would point instead to infection or hemorrhage.